New Program Provides Nutritional Help for Mexico's Poorest Residents - 2004-06-02

A nutrition program that provides special help to some of Mexico's poorest residents is proving effective at reducing anemia and increasing height, which is a key marker for child development. The study is published this week in JAMA, a journal of the American Medical Association.

Poor nutrition remains a serious and stubborn health problem, and a leading cause of death for young children, especially in the poorest countries.

"Worldwide, more than half of the yearly 10.8 million deaths of children less than five years are attributable to malnutrition," explained Mexican public health researcher Juan Rivera, citing statistics from the World Health Organization. Undernourished children are less likely to survive disease than children who get a balanced diet.

In 1997, Mexico began a program called Progresa - later renamed Oportunidades - aimed at improving education and health for low-income children. The theory behind it is that these are long-term investments, which will pay off when the children grow up to be healthier, more productive adults. Mr. Rivera says Progresa includes several elements.

"The first one is the provision of nutritional supplements to all children from 4-23 months of age. This is the period in life when children are at the highest risk of undernutrition, and when nutrition interventions have the highest effects," he explained.

The program also includes cash payments, some of which are linked to school attendance.

Progresa is expensive, costing $2.3 billion last year. Are Mexican taxpayers getting a good return on their investment? Juan Rivera says yes - his survey indicates a positive change in the health of Mexican youngsters in the program. He compared the height of children who were in the program for their first two years of life, against a control group that began getting the nutritional supplement only after their first birthday.

"You can see in the lower socioeconomic status children who receive the intervention during the two crucial years between birth and 24 months of age had a height which was 1.1 cm. more than the group that received the program only during the second year," he says.

JAMA Editor-in-Chief Dr. Catherine DeAngelis notes that height is one of the best indicators of how a young child is developing.

"As a pediatrician I can tell you that, as you're looking at children's development, especially their cognitive and behavior and motor [skills], head circumference is the best marker. The second-best is height," she said.

In addition to the better growth shown by the Progresa children, one-year-olds who were in the program had lower anemia rates than those not in. But children who started in the program at age one reduced their anemia rate to a level similar to those who had been in the program from birth.

Dr. Rivera points out that the survey may understate the potential benefits of the Progresa program, since many children who were getting the nutritional supplement were actually not eating it.

"Between 40 and 50 percent of children were not consuming the supplement regularly, and despite that, we show effects on growth," Dr. Rivera said.

Several other countries in the region have shown interest in the Progresa program, and Dr. Rivera said similar programs might also be suitable for middle-income developing countries elsewhere.